Comparison of the haemodynamic effects and seizure activity during modified ECT with thiopentone and propofol used as inducing agents.

Abstract

Electroconvulsive therapy is also known as Electroshock or Shock therapy or Electroplex. Seizure activity produced by ECT is considered as the therapeutic aspect of this form of treatment, but is accompanied by untoward physiologic consequences, mainly cardiovascular and cerebral in nature. The hemodynamic effects can have a significant impact in patients with underlying cardiovascular disease.The effects of certain anesthetic agents may render seizure activity difficult to generate,and the unmodified physiologic consequences of treatment may be harmful. At the present time, a number of medications have been used during ECT including pretreatment sedation, anaesthetic agents, muscle relaxants, anticholinergics, and drugs to attenuate parasympathetic and sympathetic responses. This single blinded study was carried out on 100 adult patients equally divided into two groups of 50 each to compare the Hemodynamic effects and seizure activity of thiopentone sodium (GroupT) and propofol(Group P) when used as inducing agents in patients undergoing modified electroconvulsive therapy (MECT). Results showed propofol maintained significantly better haemodynamics compared to thiopentone and seizure time was significantly lower with propofol compared to thiopentone with equal theurapeutic effect and comparable complication rate of MECT. Recovery from anaesthesia post MECT was significantly quicker with propofol compared with thiopentone. Hence,we conclude that from anaesthesiologist's point of view propofol has advantage over thiopentone when used as an induction agent for modified ECT due to its favorable haemodynamics and early recovery characteristics. (3) . The hemodynamic effects could have a significant impact in patients with underlying cardiovascular disease. The effects of certain anesthetic agents may render seizure activity difficult to generate, and the unmodified physiologic consequences of treatment may be harmful.During the few seconds following ECT stimulus there may be temporary drop in blood pressure. This may be followed by a marked increase in heart rate which may then lead to a rise in blood pressure.Upon awakening, a patient may experience a brief period of confusion, headache or muscle stiffness.Since no surgical procedure accompanies ECT, any morbidity or mortality is especially unfortunate, and may be consequent only to treatment or to the anaesthetic. Therefore the practicing anaesthesiologist must be prepared to manage these patients in a fashion that promotes effective seizure activity and simultaneously attenuates the physiologic effects of therapy